The common itch: the skin picking disorder

Skin picking disorder is little known yet widely experienced condition belonging to a group of disorders known as body-focused repetitive behaviours, which are characterised by repetitive auto-destructive actions towards own body. Examples include hair pulling, nail biting, and teeth grinding. Person with the skin picking disorder feels a frequent compulsion to pick their skin, resulting in skin damage. Different body parts and any type of skin irregularities can be targeted, for instance blemishes, scabs, dry skin, or healthy skin. Skin picking often causes a range of difficulties in daily living, including impact on health, appearance, self-esteem, and social life. People feel guilt and shame about their appearance associated with bodily marks and scars caused by the picking, and often put significant effort into masking these through clothing, make-up, and avoidant behaviour.

In fact, considering that the condition is estimated to be present in around 3% of the population (comparison: schizophrenia 1%, autism 1%, depression 9%), it is a significant public health issue. Paradoxically however, knowledge and understanding of the skin picking disorder seem low. Many people don’t know that it is an actual condition with its own psychiatric label, criteria and treatment; therefore they often do not look for professional help. Conversely, healthcare staff commonly fail to identify the disorder or they see it as a simple nervous habit. This leads to many people struggling and not getting the right help. Furthermore, the support that is currently available, that is psychotropic medication and psychotherapy such as the popular cognitive-behavioural therapy (CBT), are only moderately effective as many people quickly relapse and return to the behaviour. This might be happening because we do not yet fully understand this disorder and something is not being addressed in the process of treatment.

Generally, the research appears to be very much focused on symptoms, with origins of the disorder remaining unknown; we understand a bit about how the disorder works but we still do not know why the disorder develops in the first place. Using the attachment could help to explore this. Attachment refers to our core beliefs and ways of relating to self and others, broadly classified as secure and insecure. It is developed in childhood and carried into adulthood. In psychology this framework is known as developmental. My research aimed to look at the relationship between attachment, emotion regulation, and skin picking.

Overall, the study demonstrated a relationship between insecure attachment and skin picking severity, and that this is to some extent controlled by problems with regulating emotions. It means that the factors associated with attachment (e.g. our core beliefs; whether we are trusting, expressive, feeling worthy and secure in relationships, believing the world is good etc. or the very opposite of this) have impact on how severe the skin picking is. People with insecure attachment were found to have more severe skin picking.

Introducing developmental approach to the field of study of skin picking disorder and demonstrating a relationship with insecure attachment provides much needed clues about potential origins of the disorder, opens new research avenues, and offers support for treatments addressing emotion regulation and relational issues. This is an alternative to the trends currently dominating in the area which focus on observable symptoms and behaviourally-oriented therapies of the likes of CBT, which do not emphasize enough the role of deeper underlying issues associated with regulating emotions and with attachment. Using the developmental approach and stressing the role of the factors mentioned above can potentially improve treatment and help people get better.

About the Author

Marta IsiborMarta Isibor: Multiple award-winning recent BSc Hons Psychology graduate from Queen Margaret University (QMU; Edinburgh, UK) with strong academic involvement.
Currently enrolled on a Master in Research programme at QMU. Plans to pursue Doctorate in Clinical Psychology and to remain actively involved in research. Gained research assistant experience within QMU cognitive psychology lab. Currently honorary assistant psychologist at Royal Edinburgh Hospital. Engaged in clinical work and research concerning psychiatric rehabilitation in severe mental health disorders, chiefly treatment-resistant schizophrenia.
Particular area of academic interest involves body-focused repetitive behaviours such as skin picking, hair pulling, and nail biting.
Joined PsyPAG (Psychology Postgraduate Affairs Group) Quarterly journal as an editor in July 2017.
Happy to connect via LinkedIn and ResearchGate.

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